ABSTRACT
To evaluate and compare the anatomical [central macular thickness] and the functional [visual acuity] outcomes associated with a single intravitreal injection of bevacizumab [Avastin] versus triamcinolone acetonide for the treatment of diffuse diabetic macular edema. The study included 74 eyes [56 patients] with diffuse diabetic macular edema, which were randomized into 2 groups according to the line of treatment used; bevacizumab group [group B] and triamcinolone group [group T]. The inclusion criteria are diffuse diabetic macular edema with fluorescein angiography evidence and central macular thickness [CMT] of at least 400u as measured by OCT. All eyes were subjected to complete ophthalmic examination, including best corrected visual acuity [BCVA] with the logarithm of minimal angle of resolution [log MAR], lOP and fundus biomicroscopy. Fundus photography of the macular region, fundus fluorescein angiography and OCT were performed for all eyes at baseline. 1.SmgIO.6m1 of bevacizumab or 4mgIO.lml of triamcinolone acetonide was injected into the vitreous cavity using a 27-gauge needle inserted through the inferotemporal pars plana 3.5mm from the limbus Patients were scheduled for follow-up examinations at 1, 4, 8, 12 and 24 weeks postoperatively. The outcome measures are the changes in CMT, changes in BCVA and any reported complication. There was no significant difference between the baseline mean CMT and mean BCVA [log MAR] of both groups [p>0.05]. Four weeks following the intravitreal injecthin, there was significant improvement in the mean CMT of both groups, but the difference between both groups was not statistically significant. The mean BCVA [log MAR] was significantly improved in both groups [p<0.05]. At 12 weeks, the mean CMT was still better than baseline in both groups, but this improvement was significant in group T only. The difference between both groups was statistically significant [p < 0.05]. The mean BCVA [log MAR] was significantly better in both groups and this improvement was significantly better in group T also. At 24 weeks, the mean CMT has increased to approximate the baseline again with a corresponding deterioration in the mean BCVA in both groups. In group T, the mean TOP was increased throughout the study and the maximum increase was reported at the 4th week [p < 0.05]. In group B, no significant change in the mean TOP was reported during the follow-up period. A single intravitreal injection of triamcinolone acetonide may be associated with greater beneficial effects on vision and central macular thickness than a single intravitreal injection of bevacizumab for the short-term management of diffuse diabetic macular edema. However, careful monitoring of the TOP should be done in eyes receiving triamcinolone acetonide
Subject(s)
Humans , Male , Female , Antibodies, Monoclonal , Triamcinolone , Comparative Study , Diabetes Complications , Treatment OutcomeABSTRACT
Disorders of the visual function in migraineurs have been recognized by neurophysiological methods for many years. However, studies of the cortical visual evoked potentials have yielded contradictory results. Changes in the retrobulbar hemodynamic in migraineurs with visual auras, have not been researched extensively. The aim of the present work is to study the visual evoked potentials as well as the blood flow velocity, pulsatility index [PI] and resistance index [RI] in the ophthalmic and central retinal arteries in migraine patients with and without aura. The present study included thirty five migraine patients and fifteen healthy control subjects. Twenty patients have exclusively migraine with visual aura [MA], and fifteen without aura [MO]. The study was carried out during the headache-free periods, and all the patients and control groups were subjected to: complete general examination, thorough neurological and full ophthalmic examination, pattern-shift visual evoked potential [PS-VEP] assessment, and color doppler sonography of the ophthalmic [OA] and central retinal [CRA] arteries. PS-VEP assessment showed prolongation of the N75, P100, and N 145 latencies of the MA group, than in the MO and control groups, but significant difference was found only between the N75 and N145 latencies of the MA and control groups [P= 0.032, 0.039 respectively]. The mean P100-N145 amplitude of the MO group was significantly higher than that of the control group [P=0.021]. The mean P100-N145 amplitude of the MA group was lower than that of the MO group but still higher than the control group although none of the differences reached significant level. The mean PI of OA and CRA, mean RI of CRA, and mean end diastolic velocity of the CRA were significantly higher in MA group than in the control subjects. Migraineurs without aura [MO], when compared to the controls, they showed the same trend as the MA group, but none of the differences was statistically significant. The present study gives support to the role of cerebrovascular factors and ischemic damage in the prolongation of the VEP wave latencies and decreased P100 amplitude in migraine patients with visual aura. It also showed evidence of dysfunction in the retrobulbar circulation and hemodynamic changes that may explain some of the visual symptoms reported by most migraineurs